I’m sorry I was your last memory before dying

I’m sorry.

I really am.  No one deserves breast cancer.  Especially the kind that spreads to your liver, lungs and brain.  The fact that you lived to your eighth decade doesn’t detract from the sadness.  You deserve to live.  I can’t blame you for not being ready to go.

I apologize that our meeting was so abrupt.  I was consulted to see you in the nursing home to address various issues.  I swept in the door, and introduced myself to you and your daughter. I explained what the word “palliative” means, and why I was asked to see you.  Although I saw a full hospice consult in the hospital chart, you both stared at me blankly as if this was the first time you heard of such things.

I asked if you were in pain.  I asked about your breathing as I watched your chest move back and forth laboriously, and your dreadfully weak body sink into the gigantic hospital bed.  Finally, I tried to discuss prognosis.

You mentioned how your oncologist said that “we can get it all.”  You placed great hope in the upcoming brain radiation.  When I pushed further, you had vague ideas about seeing your grandson’s wedding that was slated for next fall.

Your skin sallow, your breath heavy, there was absolutely no way you were going to be alive for that wedding.   I had doubts about the weekend.  When I started to express my concerns that your expectations were unrealistic, the conversation turned.  Your daughter shook her head and her glance shot arrows through my chest.  You became angry and shooed me out of the room.  I was asked not to return.

I thought of a million ways I could have done better.  I should have approached the situation differently.  I could have brought these subjects up over many visits and allowed you to come to conclusions on your own.

But for some reason, I felt a great sense of urgency.  Rounding the next morning in the nursing home, I found your bed empty.  You coded an hour after I saw you.  The ambulance came, life support was initiated, and now you lie half dead in the local ICU.  Your daughter is left to make the horrible decision of when to pull the plug, if ever at all.  You will not recover.

Some may think that I write this post to gloat; to say I told you so.  The truth is agonizingly more complex.  I wish I could do this one over.  I wish I could have left you in your mist of denial, and taken a more simple approach.  I could have held your hand, said I was sorry, and let sleeping dogs lie.  Your weren’t going to listen to me anyway.

Now, I am stuck with the great possibility that your daughter will see my visit as the straw that broke the camel’s back.  And you, your last memory before dying, will be of some young pompous doctor who walked into the room, and told you he was giving up on you.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • azmd

    A good doctor is not perfect; who is perfect? No one. A good doctor is someone who notices when he could have done things better, and learns from that experience. You are a good doctor.

  • Queequeg

    Aww, Man If it is any consolation, I forgive you.

  • NormRx

    We all have had issues in our lives where we say “if I had it to do over, I would——–.” Don’t beat yourself up over this. It certainly wasn’t the first time in your life where you have regrets over your actions and it certainly will not be your last. The only thing we can do is learn from our experiences and try and do better next time.

  • NewMexicoRam

    There was no guarantee, that no matter what you did or said, that it would have changed their responses. To them, the medical system guarantees a perfect life, with no pain or sadness, and it was up to them to find it, somewhere, somehow.

  • Med School Girl

    This brought tears to my eyes. So beautiful, yet so understandable, from all aspects and points of view!

  • Jane Infidel

    Sometimes I think docs are so used to being competitive and debunking that they forget they can’t be like that with their patients. I don’t mean you specifically. I mean docs in general. They forget they are not talking to a medical student or challenging another doctor. When she mentioned seeing a wedding next year and beating the cancer that was her way of saying, “Never tell me the odds!”

  • F. Anthony Edwards

    Sob!

  • cerissa

    Iit is heartbreaking to see anyone suffer the misery of cancer. I’ve cared for dear friends, one now on morphine drip, other two I visit in the cemetary. I also know the sting of personal suffering as I have Stg4 BC. Sadly, doctors give up on you, I was told to put my affairs in order, but, and yes, to my oncologists predictions that I would be long gone by now, I am thriving. TELL THE TRUTH DOCTORS – There is a cure. I turned to CesiumChloride to rid the beast in my bones and dammit, it works! I’ve researched, read, studied, gotten stats from NCI and someone is lying thru their teeth and lying just to protect the drug co’s, the AMA, the FDA, all those “so-called” associations that collect thousands in the name of a cure…hell, there is a cure. READ: GENOCIDE-The CancerCure Coverup/ Kathleen Deoul. The threats, the underhanded intimidation, all the lying by industry to protect their 500Billion Dollar Industry, who cares if the bodies pile up, we have to have our “business” protected. Women are FORCED to undergo a hideous mastectomy, chemo/rads/lymph removal and then the ever enchanting reconstruction. I bypassed, I had LaserSurgery, no pain, no disfigurement, it cleans out the chest wall and puts you at miniscule risk of cancercells escaping into the body. Within 3 months I had no cancer in any soft tissue, lungs/liver/thyroid clear, now nothing in the ribs, and pelvis and spine are clearing rapidly. Tumor markers all in the normal range, CA25-27 was 103, now 40. What baloney physicians spew now that they want to be in the “group” and accept “standard protocol” – for whom? Yourself? Surely not the patient. I am old enough I remember when doctors would do anything if they thought it would help, most times it did. It doesn’t have to come in a pharmacy pkg. Example: Sittiing in my oncologists office, a young woman brought her father for his visit, we talked and she said he could not eat as the chemo had caused sores and thrush in his mouth, doc’s kept order different drugs, nothing worked. I asked if she’d used the simple Gentian Violet? NO,she’d never heard of it. Any mother over the age of 50 surely has…it will knock out thrush in 24 hours. What the hay? Please, stop the insanity, stop sending people to their deaths when you know there are many ways to beat this beast. Diet is #1, no sugars, soy, glutemates, the Immune System is the best way to keep cancer at bay, Cancer is not a Virus, or Bacterial infection, it is Anaerobic and can only be cured with the enemy of Anaerobic causes…diet, ph alkaline, cancer cannot thrive in alkaline enviornments. Most oncologists poo this, but I don’t see any great cures coming from the same old song and dance. READ: Mina Bissell, she is a top cancer researcher, she knows it is a question of having more good healthy cells and they will eradicate the diseased cells. Read: Dr. Goodacre, he knows chemo is a killer, these are both TOP cancer researchers, why don’t they get the credit they deserve? The pharmacy co’s will not allow anything except their fabulous debilitating drugs. Example: Robin Roberts, she gets cancer, go thru the routine, then what? She gets more cancer….STOP this insanity, stop saying you are looking for a cure – it’s under your nose!

  • Molly_Rn

    As an ICU/CCU nurse, I fear that the last awarness my patients had was of me hurting them starting a new IV or suctioning them. I shudder at the thought.

  • MHilditch

    We live in a death-denying culture. People don’t really believe that if they “don’t talk about it” they might not actually die. But… so many behave that way! No, this is not a perspective that doctors can bring about in a matter of hours. All the more reason to have end-of-life discussions before folks are seriously or terminally ill.

  • Elizabeth Chaitin

    I think it is honorable that you are beating yourself up for this. Well done. We have all had consults which could have gone better and this one was sad on every level. Your willingness to feel this woman’s sadness and wish you could have done better is why you will always be a good doctor.